title: Spontaneous perforation of the esophagus in a patient with achalasia.
abstract: Esophageal perforation in achalasia is rare. The risk would mainly follow pneumatic dilatation, and spontaneous perforation has not been described. We report a case of spontaneous rupture of the midesophagus in a 56-year-old woman with treated achalasia in whom the perforation occurred during a meal and was not preceded by emesis. A gastrografin swallow confirmed extravasation of contrast medium from the esophagus, and endoscopy revealed significant esophageal food stasis, consistent with achalasia, with a large tear in the midesophagus and gross mediastinal contamination. She subsequently underwent a three-stage esophagectomy with an uneventful recovery.
authors.affiliation: Department of Surgery, St. James's Hospital and Trinity Center for Health Sciences, Dublin, Ireland. Electronic address: andrewmoriarity@gmail.com.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Moriarity
authors.affiliation: Department of Surgery, St. James's Hospital and Trinity Center for Health Sciences, Dublin, Ireland.
authors.forename: John O
authors.initials: JO
authors.lastname: Larkin
authors.affiliation: Department of Surgery, St. James's Hospital and Trinity Center for Health Sciences, Dublin, Ireland.
authors.forename: Katie E
authors.initials: KE
authors.lastname: O'Sullivan
authors.affiliation: Department of Surgery, St. James's Hospital and Trinity Center for Health Sciences, Dublin, Ireland.
authors.forename: Narayanasamy
authors.initials: N
authors.lastname: Ravi
authors.affiliation: Department of Surgery, St. James's Hospital and Trinity Center for Health Sciences, Dublin, Ireland.
authors.forename: John V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D004931:Esophageal Achalasia / Q000150:complications*; D004939:Esophageal Perforation / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged
keywords: 8